Ideas of Madness: On the Intellectual History of Psychiatry

May/June 2005 · Historically Speaking 45 Ideas of Madness: On the Intellectual History of Psychiatry Petteri Pietikainen Intellectual history has had a rather low profile in the historiography of psychiatry . Until the 1960s, the field was dominated by medical professionals. Small wonder , then, that these psychiatric historians portrayed the development oftheir discipline in a whiggish and anachronistic light. They viewed psychiatric history as a story of steady scientific and humanitarian progress, culminating in the enlightened work of present -day psychiatrists. In the 1960s and the 1970s, social historians challenged this unrealistic picture of psychiatric history. They related madness to their interpretations of social development and, as they were often inspired by Foucault, institutions of power and control. Indeed, the revisionist picture of psychiatry offered by social historians was considerably more critical of psychiatric practices. Social historians have unearthed some very important facts about the psychiatric past and pointed out the blind spots of much previous historiography. They have often been interested in medical institutions, microhistorical studies ofthe everyday life in these institutions, and the perspective of the "shop floor level" (patients, nurses, administrators , daily routines) rather than in the work of physicians and other authorities. At the same time, their scholarly work has sometimes been hampered by their cherished beliefs about social mechanisms and their social constructivist views on mental illnesses and human social behavior in general. We cannot understand human activity only by studying social and political circumstances , processes, and structures. We also have to understand the mental habits of historical agents, and this is where intellectual history contributes to the history of psychiatry . Intellectual history is not so much a separate field or subdiscipline as it is a dimension of all history. My basic assumptions are that the mind is an active force in history; that thoughts have an impact on behavior; and that changes ofconsciousness can precipitate social changes. Besides, to some extent, all intellectual history is also social history, for a historian who does not pay attention to context is hardly a historian at all. The goal ofthe intellectual history ofpsychiatry is to understand the intentions, beliefs, and presuppositions of individuals who encountered madness in their daily life and/or wrote about mental suffering. Typically, such individuals were physicians or other behavioral experts, but patients are Belt and handcuffs on insane person, "Fools Tower," Vienna, Austria, undated. Library of Congress, Prints and Photographs Division [reproduction number, LCDIG -ggbain-03193]. another crucial source of information for historians of psychiatry. The problem with the study of patients is that there is often not much source material available, and the patients' views usually come through the filter of physicians' clinical evaluations. However, many patients have written letters, while others have kept diaries or notebooks. Some patients have even written books and articles dealing with their suffering. This material is valuable for an intellectual historian who is concerned with what can be called the "behavioral science ofideas," the study of the behavior of ideas and beliefs in specific situations. Ofthose who have developed this behavioral science of ideas, I would like to single out R.G Collingwood and Quentin Skinner, two major historical thinkers ofthe 20th century . Collingwood, a philosopher of history, viewed history as the history of thinking, as the mind's self-knowledge of itself. And to understand how people think, one has to conceive ofthinking as a set ofanswers to questions that preoccupy people. In order to find out what people mean when they say something , we have to know the questions they are trying to answer. Collingwood taught us that an essential aspect of historical scholarship is posing the right questions. This, as he knew very well, is quite difficult, because the questions that occupied people's minds in the past are not necessarily the same as those of today. Besides, authors did not usually explicate the questions to which they gave answers in their texts, because they mostly wrote to their contemporaries who were interested in the same questions and who understood the specific context without the author having to spell it out explicitly. And what questions are asked is determined by tacit assumptions or presuppositions (a term used by Collingwood) that remain more or...